Credit Union - Annual Return - Form AT4044



31754445ANNUAL RETURNFinancial Institutions – Policy, Treasury Board and FinanceThis form must be submitted within 30 days after the annual general meeting to Financial Institutions – Policy, FIPolicy@gov.ab.ca or 8th floor Federal Building, 9820?-?107?Street, EDMONTON, Alberta, T5K?1E7, (780) 644-5006. A copy of this form must also be submitted to the Credit Union Deposit Guarantee Corporation, Suite 2000, 10104 – 103 Avenue, EDMONTON, Alberta, T5J 0H8.The personal information that is provided on this form and the supporting documentation is collected for the purpose of administering the Alberta Credit Union Act. It is collected under the authority of section 33 (c) of the Freedom of Information and Protection of Privacy (FOIP) Act and protected by the privacy provisions of the Act. If you have any questions about this collection, please contact our office using the information provided above.Section 1Credit Union Name: FORMTEXT ?????Corporate Access Number: FORMTEXT ?????Registered Office: FORMTEXT ?????Mailing Address: FORMTEXT ?????Records Office: FORMTEXT ?????Email Address: FORMTEXT ?????Telephone Number: FORMTEXT ?????Date of the Annual General Meeting: FORMTEXT ?????Directors and Officers for Year Ending: FORMTEXT ?????Section 2BOARD OF DIRECTORS (if space is insufficient, attach additional sheets) PRIVATE Name(Please indicate Chair and Vice Chair)Mailing Address(Check box if same as in Section 1) FORMTEXT ?????? FORMTEXT ????? FORMTEXT ?????? FORMTEXT ????? FORMTEXT ?????? FORMTEXT ????? FORMTEXT ?????? FORMTEXT ????? FORMTEXT ?????? FORMTEXT ????? FORMTEXT ?????? FORMTEXT ?????PRIVATE Name(Please indicate Chair and Vice Chair)Mailing Address(Check box if same as in Section 1) FORMTEXT ?????? FORMTEXT ????? FORMTEXT ?????? FORMTEXT ????? FORMTEXT ?????? FORMTEXT ????? FORMTEXT ?????? FORMTEXT ????? FORMTEXT ?????? FORMTEXT ?????OFFICERS WHO ARE NOT DIRECTORS (if space is insufficient, attach additional sheets)PRIVATE Name and Title(s)Mailing / Business Address (if different from Section 1)BusinessTelephone no. FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ??????Check here if additional sheets are attached.Section 3SUBSIDIARIES (List the names of all the credit union’s subsidiaries) FORMTEXT ?????CERTIFICATIONWe certify that the particulars set forth in the foregoing statement are true and complete.67627515240000494728515303500President:Date:Name and Signature495681017081500Secretary:Date:7048501397000Name and SignatureNOTE: The personal information that is provided on this form and the supporting documentation requested by it, is collected for the purpose of making a determination as to your competency, character, financial resources and fitness to hold shares or be a director or officer, of a corporation that is (or is proposed to be) regulated under the Credit Union Act, as set out in sections 9 and 41 of the Credit Union Act. ................
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